What the ASQ_SE is by malj


   Research-based social and emotional
    screening test
   An easy, 10-15 minute face-to-face
    “interview” with parents of children between 6
    months and 5 years of age
   A conversation starting tool that helps staff
    learn about a child and his/her parent’s
   Available in both English and Spanish
   Able to be copied- you don’t have to use an
    original questionnaire, but can use a copy
 It is NOT something you
  send home with the
 It is NOT used to
  diagnose a child
What about the
§ 1304.20 (b) (1):
(b) Screening for developmental, sensory, and
  behavioral concerns.
  (1) In collaboration with each child's parent, and
  within 45 calendar days of the child's entry into
  the program, grantee and delegate agencies
  must perform or obtain linguistically and age
  appropriate screening procedures to identify
  concerns regarding a child's developmental,
  sensory (visual and auditory), behavioral, motor,
  language, social, cognitive, perceptual, and
  emotional skills (see 45 CFR 1308.6(b)(3) for
  additional information). To the greatest extent
  possible, these screening procedures must be
  sensitive to the child's cultural background.
Head Start:
 The Head Start child must have a new
  questionnaire completed at least once a year
  within 45 days of enrollment.
Early Head Start:
 The Early Head Start child must have a new
  questionnaire completed at least every 6 months
  until the age of 3.
 The ASQ:SE needs to be completed with EHS
  children within 2 weeks of the child reaching the
  next age (i.e., within 2 weeks of the child turning
  18 months old)
   The screening form comes in eight different
    ages: 6 months, 12 months, 18 months, 24
    months, 30 months, 36 months, 48 months,
    and 60 months.
   Use the child’s chronological age in months
    to determine which form to use. The front
    page has the age (in months) at which each
    form should be used.
   In EHS, we start using the 6 month form at 4
   Use BLUE INK to fill out the questionnaire!
   Sit face-to-face with the parent or guardian
    while you ask the questions. DO NOT JUST
    ◦ If not done face to face, the parent may not
      understand all questions and may not answer
    ◦ Doing the questionnaire with the parent will give
      you more insight into how to best work with the
      child in the classroom
   Fill out all of the blanks on page 2 with the
    family’s information.
    ◦ Write the parent’s name in the “Person filling out
      this questionnaire” blank
    ◦ List your (staff’s) name under “List people assisting
      in questionnaire completion”
    ◦ Write the center name in the blank next to
      “Administering program or provider”
   Go through all of the questions with the child
    and mark the appropriate boxes based on the
    parent’s response (“Most of the Time”,
    “Sometimes”, or “Rarely or Never”).
   Also note any “Concerns” the parent has by
    marking the circle in the last column for the
    appropriate question(s).
   Fill out the short answer questions, starting
    on page 6, with the parent’s responses.
   Fill out the top portion on page 8 with the
    same information entered on the front page.
   Go back through the questionnaire and tally
    up the points using the following point
    ◦ Z (for zero) next to the checked box              =0
    ◦ V (for Roman numeral V) next to checked box =5
    ◦ X (for Roman numeral X) next to checked box =10
    ◦ Checked Concern                                   =5
    **NOTE: The codes Z, V, and X do NOT correspond
      with a certain column. X could be the first column
      or the third. Pay attention to which letter is next to
      the marked box on EACH question!
   Total the points on each page (3, 4, 5, and 6)
    and copy those totals on the appropriate
    blanks on page 8.
   Add up all four scores and write the total next
    to “Child’s total score”.
   Take note of those individual questions that
    score 10 or 15 points and any written or
    verbal comments the parent shares. Use
    these as you make referral considerations.
   Transfer the child’s total score to the chart in the
    lower-middle of the page.
   Compare the child’s score with the cutoff score
   If the child’s score falls ABOVE the cutoff score,
    complete an ICOPA (Individualized Child
    Outcome Plan of Action) with the parent.
   On the ICOPA, the parent can choose to either
    have the child rescreened in 2 weeks or have an
    immediate referral to Mental Health & Disability
   If the parent requests a referral, fill out a Referral
    Form and submit through inter-office mail to
    Mental Health & Disability staff.
   Remember to document all screenings and
    ICOPAs in Child Plus before filing the forms in
    the brown folder.
   ALL screenings are confidential and need to
    be locked up when they are not being used.
What does ASQ:SE
stand for?
Head Start children must be
screened using the ASQ:SE within
how many days of enrollment?
The ASQ:SE can be sent home
 with the parent and returned
 to the center the next day.
What writing utensil
should you use when
completing the ASQ:SE
What do you need to do
after completing the ASQ:SE
if the child’s score is above
the cutoff?
 You have now completed the
training for the Ages and Stages
Questionnaire: Social-Emotional!

If you have any questions, please
         feel free to contact:
  Jennifer Crookham: 891-2156
     Blanca Herron: 893-5827
      Leigh Wells: 893-3167

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